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The Part 1 FRCOphth (hereafter referred to as Part 1) is the first of four examinations required for a Fellowship in Ophthalmology (FRCOphth) awarded by the Royal College of Ophthalmologists (RCOphth). It is considered to be one of the toughest exams in ophthalmology training, with an average pass rate of 44% in 2017 (cf. 62% for the Refraction Certificate, 62% for the Part 2 FRCOphth written and 60% for the Part 2 FRCOphth oral).1 It also has the lowest pass rate (39%) and is the most expensive (table 1) of any entry-level postgraduate exams undertaken by foundation doctors in 2017.2 Unlike other popular entry-level postgraduate exams (eg, MRCP Part 1) where the syllabus directly extends from medical school curricula, the knowledge required for the Part 1 is mostly non-transferrable.
At present, foundation trainees in the UK are only permitted to sit the Part 1 following full General Medical Council registration (ie, after completion of foundation year 1).3 The exam is not a mandatory requirement prior to commencing Ophthalmic Specialist Training but ophthalmic trainees are required to pass it before entering into the third year of their training.
Part 1 aims to assess a candidate’s ‘understanding of patient investigations and knowledge of basic and clinical sciences relevant to ophthalmology’.4 Consequently, there is a heavy emphasis on key areas such as anatomy, optics and basic sciences as well as common clinical investigations in ophthalmology. The 1-day exam consists of a 3-hour multiple choice question (MCQ) paper of 120 questions, followed by a 2-hour Constructed Response Question (CRQ) paper of 12 questions.
Weightage in ST1 application
As of 2018, passing Part 1 awards 6 out of the possible 100 points for the portfolio component of the ST1 application which in turn carries a total maximum score of 310. In other words, it accounts for 6% of the portfolio score and approximately 2% of the total ST1 application score.
Pros and cons
There is ongoing debate as to whether Part 1 is worth attempting in foundation years. Objectively, passing the exam provides a small but not insignificant 2% advantage, especially considering the increasingly competitive nature of ST1 application. The main pros and cons of doing Part 1 during foundation training are shown in table 2; these should be carefully balanced to make an informed choice.
For core reading material, it is important to consult the college’s latest recommended reading list.3 The current consensus on essential books to read for the main topics in Part 1 (anatomy, optics and basic sciences) are (1) Clinical Anatomy of the Eye by Snell, (2) Clinical Optics by Elkington and (3) The Eye: Basic Sciences in Practice by Forrester, respectively. Go through these books at least once as many exam questions are directly fetched from them.
Always supplement core reading with practice questions and do as many of them as possible. This is especially true for the ray diagram questions for the CRQ paper; learn to draw them by rote as they are inevitably tested in each paper. Doing so will help refine your exam techniques, familiarise yourself with the terminology used in the actual exam and ultimately give you a much stronger chance of passing. Some of the widely recommended resources for practice questions are shown in box 1. There are also revision courses available which some may find helpful, but it is important to be aware that these have received mixed reviews and are currently not endorsed by the RCOphth.
Useful resources for practice questions
FRCOphth Part 1: 400 SBAs and CRQs (Hall and Peden)
MCQs for FRCOphth and ICO Basic Sciences Examinations (Trikha, de Silva, Mehta, Keightley)
MCQ Companion to the Eye: Basic Sciences in Practice (Galloway, Forrester, Dick, Lee)
ReviseAid FRCOphth Part 1
Past exam questions are another key to exam success. Get hold of them by either looking through websites such as Eyedocs for previous exam feedback or directly asking previous candidates for past answer sheets. They provide invaluable insight into what the common exam themes are and how questions are structured. It is also useful to scrutinise the college’s official examination reports to identify topics that candidates perform less well on and to focus revision on those areas.
As with any exam, advanced planning is essential. To begin with, aim to secure a supernumerary or ‘unbanded’ placement for your first rotation in F2 year. Despite Part 1 having three sittings per year, it should be attempted during the first F2 rotation (usually around October) for it to be of any benefit for ST1 application in the same academic year. There is usually a more flexible working pattern with a supernumerary placement and one should capitalise on the extra time that comes with it for exam prep. Some examples of specialties that offer supernumerary posts at foundation level include ophthalmology, psychiatry, radiology, public health, anaesthetics and microbiology. The best-case scenario would be a F2 post in ophthalmology as there is a threefold benefit of having ample time to revise, learning while working in a conducive environment and demonstrating commitment to the specialty all at the same time.
Next, devote at least 3–4 months of solid revision for Part 1. Set aside a few hours a day to go through the recommended reading material. This can start out as sporadic reading for the first month or so, followed by longer and more intense sessions nearer towards the exam. It is also advisable to focus more on practice questions in the last few weeks of revision which will be of higher yield at that stage.
Lastly, try to book at least a week’s worth of study leave just before the exam to allow yourself to get into the zone and plough through as many questions as possible. Most trusts allow F2s to take leave for private study up to a maximum of 7 days, but policies differ between hospitals so remember to keep abreast of your leave entitlements before finalising your revision schedule. If the above fails, consider using your annual leave instead; it will be a sacrifice worth making.
Despite Part 1 being a tall order in foundation years, it is achievable with some hard work, dedication and meticulous planning. Persevere and it will pay off.
Contributors PYS conceived the idea for this manuscript and was responsible for the first draft, revision, critical appraisal and approval of the final version for publication.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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